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Inspection carried out on 11 November 2019

During a routine inspection

About the service

Mortimer House is a residential care home providing personal and nursing care to 20 people with learning difficulties and/or dementia. The service can support up to 28 people.

The care home accommodates up to 28 people in one adapted building, over two floors.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 28 people. 20 people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and being close to local amenities.

People’s experience of using this service and what we found

People received care from staff who were kind and caring in their approach. There was a high use of agency staff, however the impact of this was mitigated by the service using the same agency staff whenever this was possible. The service was actively recruiting to vacant posts. Our observations showed that staff treated people with respect. People received support in line with their identified needs at key times such as meal times.

Staff reported feeling happy with their training and support and told us staff morale was improving. They told us communication was getting better and that they had handovers at each shift to discuss key information.

Staff worked with health and social care professionals to ensure people’s needs were met. Community health professionals held a clinic at the home once a fortnight to review and advise on people’s nutritional and eating and drinking needs. There had been some concerns around how well staff were following these guidelines; however shortly after the inspection, we received feedback that this was improving. During our inspection we observed a meal time when people received good support.

Staff knew and understood people’s individual needs well and told us about their likes and preferences. Care plans were written in a person centred manner and had been recently updated. People had opportunity to take part in activities both on an individual basis and in group settings such as arts and crafts.

We saw improvements in the home since the last inspection and it being rated as requires improvement. The registered manager was being supported by the organisation to make improvements. There was an action plan in place. The provider had been working with the local authority safeguarding team due to concerns raised by health professionals. We made one recommendation under Well Led to continue to review record keeping, due to inconsistencies we found in some people’s care plans.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of registering the right support.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Inspection carried out on 7 August 2019

During an inspection looking at part of the service

About the service

Mortimer House is a residential care home providing personal and nursing care to 28 people aged 65 and over. At the time of the inspection there were 21 people at the home. Mortimer House accommodates people across two separate floors of the home. Each of which has separate adapted facilities. One of the floors specialises in providing care to people living with dementia and a learning disability.

People’s experience of using this service and what we found

Before our visit a safeguarding allegation had been reported internally by a member of staff. This had not been addressed. This was then reported to a Commissioner for the service who was visiting the home. This led to a second serious safeguarding allegation being made about the same staff member. This also led to allegations that there were not enough staff at the home to meet safely meet people's needs.

People were not always supported to be safe. This was seen during our visit when a staff meeting took place. Every permanent member of staff went to the meeting. This left agency staff to support people. The agency staff were caring and worked hard to support people. However, at one point one agency staff member needed support with the needs of a person. They asked another agency staff member. This left one lounge with people in it unsupervised for several minutes. This in turn could have put those people at risk.

The service was not always safe in other ways. For example, it had been identified that staff handover meetings did not take place at 1pm when a number of staff came on duty. The service was not always safe as no actions had been taken to address this by management. It had also not been formally picked up that four new staff had not had a full staff induction programme.

Staff were kind and caring. They supported people with their needs promptly. People told us they felt happy living at the home.

The provider had taken clear action after a serious allegation of abuse was made to a visiting social care professional. They had seconded a very experienced registered manager and other staff from another of their services. These staff were working at the home to support the service.

We have identified a breach in relation to a lack of staff training and induction for new staff at this inspection. We also found a continued breach of the regulations around good governance.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection.

The last rating for this service was Require Improvement when the service was inspected in September 2018. The service remains rated as requires improvement. The service has been rated requires improvement for the last four consecutive occasions.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We received concerns in relation to the safety of people at the home. Specifically, a significant allegation of abuse had been made about a staff member. This had not been swiftly and robustly addressed by the service. As a result, we undertook a focussed inspection to review the Key Questions of Safe and Well Led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection. The inspection was prompted in part due to concerns received about the safety of people after a recent concern was raised with us via the Local Authority. This concern led us to believe people’s safety could be at risk. A decision was made for us to inspect and examine those risks.

We found evidence that the provider needs to make improvements. Please see the Safe and Well Led key question sections of this full report.

You can see what action we have asked the p

Inspection carried out on 27 September 2018

During a routine inspection

The inspection took place on 27 September 2018 and was unannounced.

Mortimer House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Mortimer house accommodates up to 28 people in one adapted building. At the time of our inspection 22 people were living at the home. Accommodation is spread across two floors. The home provides care to people with learning difficulties, dementia and those in need of palliative care.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People received support from staff who were kind and caring and clearly wanted to do their best for the people they supported. However, there were areas of the service where improvements were required. There was evidence of good practice in relation to the MCA and DoLS and it was clear that the service understood the principles of this legislation. However, there were lapses where it wasn’t evidenced that people’s rights had been fully protected. For two people who had conditions on their DoLS authorisations, it wasn’t clear whether these had been met in full.

Staff told us that there had been some challenges at the service with high use of agency and bank staff. Where possible, bank and agency staff familiar with the service were used to minimise the impact on people using the service. Some staff reported morale being low due to all the changes that had occurred. The registered manager told us new staff had been recruited and were in the process of having checks completed. They hoped that this would lead to a period of stability for people using the service and the staff team.

Record keeping was inconsistent. There were areas of good practice but also evidence that records were not always completed fully.

Our observations throughout the day showed that people were treated with dignity and respect. People received comfort and reassurance when needed. Staff used humour to engage people and help build positive relationships. Staff understood people’s individual needs and preferences for care and talked to us about the ways in which they provided this.

People’s nursing needs were met and staff worked effectively with other healthcare professionals to ensure this was the case. We saw evidence of people receiving support from the speech and language therapist, dietician and GP. During our visit, there was a review taking place of one person’s complex health condition. Staff were knowledgeable about this person’s condition. Staff also demonstrated good knowledge about people’s dietary requirements and whether they needed a modified diet to reduce the risk of choking.

Inspection carried out on 7 February 2017

During a routine inspection

The inspection took place over two days on 7 and 14 February 2017 and was unannounced. The service was last inspected in December 2015 and was given a rating of ‘requires improvement’. No breaches of legislation were found.

The service provided nursing care and accommodation for up to 28 people with a diagnosis of dementia and/or learning disability.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that improvements to the service had been made since the last inspection. The process for administering medicines had improved. Pharmacist and GP support had been sought to review people’s medicine regimes and this had reduced the need for crushing medicines.

We also found that improvement in supervision of staff had taken place so that staff were meeting regularly with a senior member of staff to discuss their performance and development needs. Staff reported feeling well supported and told us that managers were approachable so they felt able to raise issues and concerns.

People were safe. There were sufficient numbers of staff to ensure their needs were met. Staff spoke positively about how they had time to spend with people between care tasks and that staff worked together as a team to ensure people’s care needs were met.

People were supported to ensure their health needs were met. Staff worked with healthcare professionals such as speech and language therapists, dieticians and district nurses.

People received good care and were treated with dignity and respect. . We observed that people experienced positive relationships with staff and other visitors to the home. People were able to maintain relationships with their families.

Staff understood people’s individual needs and people were able to follow their own daily routines. We observed that people were able to get up and ready for the day at a time of their choosing. There was a programme of activities for people to take part in if they wished to. People had opportunity to go out in their local community.

The home was well led, with a registered manager in place supported by a deputy manager. There was an open and transparent culture in the home. Staff were well informed about the issues arising from the last inspection and there was also information on display in the home so visitors were aware of the improvements required.

Inspection carried out on 17 December 2015

During a routine inspection

We inspected the service on 17 December 2015. This was an unannounced inspection.

Inspection. The service was last inspected in January 2014 when it was compliant with the regulations at that time.

The service is registered to provide accommodation and nursing care for up to 28 people. People who use the service live with a learning disability and/or a diagnosis of dementia. At the time of our inspection there were 27 people living at the home.

There was a registered manager for the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that the procedures for giving people their medicines were not fully safe. Nurses were not always following the providers own procedure in relation to ensuring that staff had safely given people their medicines. There was a lack of readily available guidance for staff. Specifically there was no information easily available to ensure that medicines which people needed crushed were given to them safely.

Staff supervision was not up to date. This could impact on the quality of the service people received if staff were not properly supported and guided in their work.

The system for checking the quality of the care and service people received was not fully effective. Shortfalls in the way the service was run had not been picked up by recent audits of the service. This meant there was a risk that the quality of care people received was not safe and suitable for them.

People were given the support they needed at mealtimes and there was a plentiful supply of food and drinks provided for each person based on their preferences.

Staff demonstrated that they were knowledgeable about their responsibility to protect people from possible abuse. They were able to explain how to recognise abuse and report concerns following the providers safeguarding procedure.

Staff were kind and caring, and they supported people to live a varied and fulfilling life in the home and in the community. Staff had a good understanding of the needs of the people they supported and knew how to provide them with effective care.

People had good access to health professionals and were supported to attend appointments. Care plans clearly explained how to meet people’s range of care needs, and included detailed life histories of each person. This helped staff to know each person and to provide them with personalised care.

People were supported by staff to make decisions in their daily lives. Staff understood about the requirements of the Mental Capacity Act (MCA 2005). The service worked with people, relatives and social care professionals when needed to assess people’s capacity to make specific decisions. Staff also understood the importance of seeking consent before providing people with all aspects of care.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 6, 14 January 2014

During a themed inspection looking at Dementia Services

This inspection was part of a themed inspection programme specifically looking at the quality of care provided to support people living with dementia to maintain their physical and mental health and wellbeing. The programme looked at how providers worked together to provide care and at people�s experiences of moving between care homes and hospital.

At the time of this inspection there were 24 people living at Mortimer House. The deputy manager told us that six people had a diagnosis of dementia and that some others were undergoing assessment of their condition to determine whether they too were living with dementia.

All of the areas of Mortimer House we saw appeared clean and fresh. People who lived in the home looked clean, tidy and appropriately dressed. Staff were open and friendly towards us and the interaction between staff, and between staff and people who used the service was friendly and respectful.

People's needs were assessed and care was planned accordingly. Care plans were reviewed at least six monthly and more frequently when people's needs changed. There was good communication between staff and records had been kept of the support and health care needs of people.

People's health was monitored and they had access to community health resources as required. There was regular access to a GP and other healthcare professionals. When people needed emergency care they were treated as far as possible at the home. If they needed to go into hospital, information about their needs was sent with them and they were supported by staff from the home for continuity.

There were arrangements in place to monitor the quality of care people received and manage any risks.

We left comments cards at the home for people to complete in order to gain their views. One person completed a comment card. They wrote "Having been a regular visitor with 48 visits throughout the year and having visited a number of care homes in the Bath/Bristol area over the last five years. I acknowledge that the care and attention I have witnessed on each of my visits to this home has always been courteous attention provided by the staff to all residents. In particular the professional Food and hygiene good. Edible and well presented".

Inspection carried out on 17, 22 January 2013

During a routine inspection

This was the first inspection of Mortimer House since the home was registered with the Care Quality Commission in 2011. The home had been purpose built and provided an accessible, well maintained and clean environment for people to live in.

People spoken with told us they liked living at Mortimer House and felt well supported by staff. For those people who were unable to tell us about their experiences, we carried out observations of how staff communicated with them and cared for them.

We saw that staff interacted with people in a friendly and caring way and people responded positively to this. When staff supported people at a midday meal we saw they supported people in a sensitive and respectful way, involving people in the conversations.

Staff were confident and knowledgeable about people's needs and the care and support they required. They showed that they happy in their work and enjoyed working with the staff team. When we asked them if they felt there were enough staff working at the home they told us it would be better if there were more staff.

People�s needs were assessed and care plans that had been developed had been reviewed regularly.

We looked at various records kept at the home showing us that people were being kept safe, that staff had received training to meet people's needs and that the quality of the service had been monitored.